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Pour on the olive oil, preferably over fish and vegetables: One of the longest and
most-scientific tests of a Mediterranean diet suggests this style of eating can cut the chance of
suffering heart-related problems, especially strokes, in older people at high risk of them.

The study lasted five years and involved about 7,500 people in Spain. Those who ate
Mediterranean-style with lots of olive oil or nuts had a 30 percent lower risk of major
cardiovascular problems compared with those who were told to follow a low-fat diet but who, in
reality, didn’t cut fat very much. Mediterranean meant lots of fruit, fish, chicken, beans, tomato
sauce, salads and wine, and few baked goods and pastries.

Mediterranean diets long have been touted as heart-healthy, but that’s based on observational
studies that can’t prove the point. The new research is much stronger because people were assigned
diets to follow for a long time and carefully monitored. Doctors even conducted lab tests to verify
that the Mediterranean-diet folks were consuming more olive oil or nuts as recommended.

Most of these people were taking medicines for high cholesterol and blood pressure, and
researchers did not alter those proven treatments, said one study leader, Dr. Ramon Estruch of
Hospital Clinic in Barcelona.

But as a first step to prevent heart problems, “We think diet is better than a drug” because it
has few if any side effects, Estruch said. “Diet works.”

Results were published online yesterday by
TheNew England Journal of Medicine and were discussed at a conference in Loma Linda,
Calif.

People in the study were not given rigid menus or calorie goals because weight loss was not the
aim. That could be why they found the “diets” easy to stick with — only about 7 percent dropped out
within two years. There were twice as many dropouts in the low-fat group as among those eating
Mediterranean-style.

Researchers also provided the nuts and olive oil, so it didn’t cost participants anything to use
these relatively pricey ingredients. The type of oil might have mattered — they used extra-virgin
olive oil, which is minimally processed and richer than regular or light olive oil in the chemicals
and nutrients that earlier studies have suggested are beneficial.

The study involved people ages 55 to 80, just over half of them women. All were free of heart
disease at the start but were at high risk for it because of health problems — half had diabetes
and most were overweight and had high cholesterol and blood pressure.

They were assigned to one of three groups: Two followed a Mediterranean diet supplemented with
either extra-virgin olive oil (4 tablespoons a day) or with walnuts, hazelnuts and almonds (a
fistful a day). The third was urged to eat a low-fat diet heavy on bread, potatoes, pasta, rice,
fruits, vegetables and fish and light on baked goods, nuts, oils and red meat.

Independent monitors stopped the study after nearly five years when they saw fewer problems in
the two groups on Mediterranean diets.

Doctors tracked a composite of heart attacks, strokes or heart-related deaths. There were 96 of
these in the Mediterranean-olive oil group, 83 in the Mediterranean-nut group and 109 in the
low-fat group.

Looked at individually, stroke was the only problem for which type of diet made a big
difference. Diet had no effect on death rates overall.

The Mediterranean diet proved better even though its followers ate about 200 calories more per
day than the low-fat group did.

Rachel Johnson, a University of Vermont professor who heads the American Heart Association’s
nutrition committee, said the study is very strong because of the lab tests to verify oil and nut
consumption and because researchers tracked actual heart attacks, strokes and deaths — not just
changes in risk factors such as high cholesterol.